916 patients ≥ 18 years of age who had out-of-hospital cardiac arrest and were treated by ambulance personnel. After excluding 65 patients who were randomized but later found to meet exclusion criteria (cardiac arrest induced by trauma, asthma, or anaphylactic shock; resuscitation not attempted; cardiac arrest witnessed by ambulance crew; or bystander physician-initiated resuscitation), 851 patients (mean age 64 y, 71% men) were included in the analysis.

Intervention

Standard advanced cardiac life support (ACLS) without IV drug administration (n = 433) or ACLS with access to IV drug administration (control, n = 418). In the no-IV-drug group, IV access was to be established 5 minutes after return of spontaneous circulation (ROSC), and drugs given if indicated.

Outcomes

Survival to hospital discharge, hospital admission with ROSC, admission to the intensive care unit, survival to discharge with favorable neurologic outcome, and 1-year survival. The trial had approximately 90% power to detect an absolute difference of 7% in survival rate with α = 0.05.

IV drugs (mainly epinephrine) were given during resuscitation to 10% of the no-IV-drug group and 82% of the IV-drug group. Patients in the no-IV-drug group had poorer short-term outcomes, but groups did not differ for survival to discharge or 1 year (Table).

Conclusion

In patients with out-of-hospital cardiac arrest, withholding intravenous drugs did not improve the rate of survival to hospital discharge.

Standard advanced cardiac life support without vs with access to intravenous (IV) drugs in patients with out-of-hospital cardiac arrest†

Outcomes

No IV drugs

IV drugs

RBR (95% CI)

NNH (CI)

Survival to hospital discharge

9.2%

10.5%

12% (−31 to 41)

Not significant

Hospital admission with return of spontaneous circulation

21%

32%

35% (19 to 49)

9 (6 to 19)

Admission to intensive care unit

20%

30%

32% (14 to 46)

11 (7 to 27)

Survival to discharge with favorable neurologic outcome

8.1%

9.8%

18% (−26 to 46)

Not significant

Survival to 1 y

8.4%

9.8%

15% (−30 to 44)

Not significant

Outcomes

No IV drugs

IV drugs

RBR (95% CI)

NNH (CI)

Survival to hospital discharge

9.2%

10.5%

12% (−31 to 41)

Not significant

Hospital admission with return of spontaneous circulation

21%

32%

35% (19 to 49)

9 (6 to 19)

Admission to intensive care unit

20%

30%

32% (14 to 46)

11 (7 to 27)

Survival to discharge with favorable neurologic outcome

8.1%

9.8%

18% (−26 to 46)

Not significant

Survival to 1 y

8.4%

9.8%

15% (−30 to 44)

Not significant

†Abbreviations defined in Glossary. RBR, NNH, and CI calculated from data in article.